Cardio Flashcards
Unintentional Intracarotid Injections in the Horse
• Accidental intracarotid injections led to seizures but did not result in death of the case when a sedative was used.
• Premonitory clinical signs such as flared nostrils, sweating and muscle tremors occurred in most cases soon after injection and can be used for early identification of this inadvertent injection.
• All cases had seizures after the injection, but subsequent complications were minor.
•One died- 30ml intracarotid gentamicin. Outcome associated with volume?
•Most injections performed by veterinarians; mostly when sedating though the jugular
•most events were 1.5” needles attached to the syringe against jugular flow.
•One horse went temporarily blind but recovered
Measurement of ANP, BNP, and Endothelin-1 in Jumping Horses with Valvular Regurgitation and their correlation with the dimensions of heart structures.
GENERALLY RUBBISH STUDY
Described an equine specific sandwich ELISA for measurement of ANP, BNP and endothelin-1
Association between BNP and valvular regurgitation, BNP and endothelin-1 and PR
ANP and endothelin-1 were correlated with ventricular width
A Clinical Audit of Intravenous Fluid Therapy in Hospitalised Horses
•Weigh each horse before starting IVFT and plot the LOBF based on an accurate weight.
• Standardise a fluid ‘check’ as part of a clinical check on the patient.
• Calculate the fluid graph based on weight. Produce a table to eliminate the need for calculation each time (Figure 7).
• For this hospital, the handover between the day and the night period was when the fluids were slower. An improved method of handover between staff could be discussed (e.g. record fluids during the handover).
Improved compliance 26%-71%. Improved standard of care
Atrial Fibrillatory Rate as a Predictor of Recurrence of Atrial Fibrillation
- for TVEC, AFR >380 increases risk of recurrence within 380 days (not for quinidine)
- recurrence was lower for quinidine group (12% vs 32%) but very different populations
- AFR was associated with likelihood of QS convertion (99% TVEC converted)
- Other RF: MR, increased LAA, AF duration.
Premature Depolarisations in Horses Competing in Eventing
56% of horses had PDs, 83% had compensatory pause; upper-level competitors more likely to have complex arrhythmias (couplets)
Time >199bpm was associated with more complex arrhythmia.
Arrhythmia at rest was associated with arrhythmia in the early recovery period.
16% had murmurs
No association with competition performance identified.
Arrhythmia in recovery associated with arrhythmia at rest.
Atrial Fibrillation as a Risk Factor for Exercise-Induced Pulmonary Haemorrhage (EIPH) following a standardised exercise test
No relationship between AF and EIPH demonstrated but AF horses achieved submaximal exercise. Not generalisable scenario (treadmill). More abnormal QRS and higher HR in AF horses
Atrial Premature Depolarisations Post-Cardioversion and AF Recurrence
Associated with recurrence within 1 year:
-APD ≥ 25/24 h at 5 days HR: 2.9
-MR HR 8.6 (Mr increased recurrence to 48%, 18% without)
-LA FAC <9.6% HR 2.6
- lower bwt (HR 0.99)
No association with AFCL but confounding intermittent sotalol/amiodarone
Median time to recurrence 125d. 36% (56% with >25 APD)
Implantable Loop Recorders can detect paroxysmal atrial fibrillation in Standardbred racehorses with intermittent poor performance
Can be used AT REST Sp 46% (huge FP rate). Could not calculate Se from study
DID NOT IDENTIFY AF AT EXERCISE- Quality poor at exercise
RMSSD increased in AF
visual inspection still required
PAF possibly happens more than we realise? 4/12 SB
Morphological Variability of the Atrioventricular Valve Cusps
39/40 valves had accessory leaflets, 2-6 for MV and 1-4 for TB. Were smaller, attached to one papillary muscle and tended to share cords with the main leaflets. Their clinical relevance is uncertain.
Possibly depends how you define accessory leaflets (bifurcation?)
Cardiac Pre-Purchase Examination in Horses- evaluation, outcome and athletic follow up
86% had a murmur at rest, 11% arrhythmia
MR> physiological> TR > AR > cardiomyopathy> aortocardiac fistula and myocarditis
PPE predictions aligned well with athletic outcomes- prognosis at the time of PPE was the only significant predictor of athletic outcome.
(signalment, auscultation findings and diagnosis did not relate to outcome or prognosis)- except bilateral and continuous murmurs (poor Px)
Full cardio assessment is therefore indicated for all murmurs or arrhythmia
Preliminary Evaluation of Reference Intervals for a Point-of-Care Viscoelastic Coagulation Monitor (VCM Vet) in healthy adult horses
VCM Vet is repeatable but varies between instiutions -> use own reference intervals. Needle size/ venepuncture site didn’t matter, output resembles ROTEM. Uses fresh blood.
Exercise-Associated Rhythm Disturbances in Poorly Performing Thoroughbreds
- 43% had isolated premature depolarizations;
- 19.6% had complex tachydysrhythmias
- most in recovery, none had tachydysrhythmia during exercise
- NH horses and horses with UAO more likely
-82% raced again regardless of group.
Pre- and Post-Race Serum Cardiac Troponin T Concentrations in Standardbred Racehorses
cTnT increases with exercise, evidence for population specific reference intervals. Requires further work for reference intervals, some possibility may be more sensitive than cTnI but this is not proven
Hypercapnia and hyperlactatemia were positively associated with higher-grade arrhythmias during peak exercise in horses during poor performance evaluation on a high-speed treadmill
Hypercapnia and hyperlactatemia correlated with severe arrhythmias at peak exercise. No association with lower airway disease demonatrated
Evaluation of the Effects of Intraabdominal Hypertension on Equine Central Venous Pressure
CVP increases with IAP up to 12mmHg, then decreases 15-20mmHg IAP. Considerations for goal directed fluid therapy. Normal mean CVP in horses 5.5-8.8mmHg. Got to a max of around 14mmHg (mean) in this study (around 10-12mmHg IAP)
Age-Related Differences in Blood Pressure and Arterial Stiffness in Horses
Older horses had thicker, stiffer arterial walls, especially in the aorta. More pronounced in central vessels (peripheral already stiffer). CO lower in older horses but no difference in BP (non-invasive). Suggests age related break down of the elastic laminae
Flow Rates of Double-Lumen Over-the-Wire Catheters for High-Volume Fluid Resuscitation
Higher flow rates achieved with shorter, wider, elliptical-tip catheters. Pressure infusion achieves rates 1.7-2x that of gravity alone. Length does not influence flow rate significantly. All achieved 40L//hr (double lumen OTW), but remember that flow can decrease by about 20% in vivo due to hydrostatic pressure etc.
A Novel Approach for Obtaining 12-Lead Electrocardiograms in Horses
May help identify and locate abberant activity, is superior to previously described technique (reduced variation in MEA, P/ QRS entropy reduced), P waves were larger and longer, generally bifid.
Effect of a Long-Term High-Energy Diet on Cardiovascular Parameters in Shetland Pony Mares
Feeding a high energy ration resulted in mild increases in BP and concentric LV hypertrophy, though all remained in physiological limits. No arrhythmia were detected, and there was no evidence of sympathetic activation in the high energy group. Limited by numbers and poor reporting of comorbidities.
Prevalence and Characteristics of Ventricular Septal Defects in a Non-Racehorse Population
Most isolated VSDs were diagnosed at a later age and not associated with clinical signs. All horses with complex CHD had clinical signs at a younger age.
Incidence, Recurrence, and Outcome of Postrace Atrial Fibrillation in Thoroughbred Horses
- AF incidence 2.7 per 1,000 starts, 4.9% of horses,
- the incidence of AF was increased if any previous episodeL 12.8/1000 starts
-Included ?ventricular (non uniform QRS) and 35% had no ECG.
-Recurrence in 25% overall, 64% of horses previously treated for AF- which was higher than those with paroxysmal. - though recurrence was high, the number of recurrent episodes did not impact career longevity or overall carreer performance. BUT only 11 horses returned to training after a persistent episode
-Median duration between episodes 343d
- though recurrence was high, the number of recurrent episodes did not impact career longevity or overall carreer performance. BUT only 11 horses returned to training after a persistent episode
Detection of the Origin of Atrial Tachycardia by 3D Electro-Anatomical Mapping and treatment by radiofrequency ablation in horses
–In 8/9, source was the RA- These cases all responded to ablation. Mostly Caudodorsal near junction with CdVC. Re-entry circuits were generally clockwise
- 6/8 horses remained arrhythmia-free at follow-up (25%)
- Complications: 1 horse had transient facial nerve paralysis. 2 had myoapthy of the triceps near the grounding catheter (resolved)
-Risk of atrial perforation
-accurate mapping essential
Transvenous Electrical Cardioversion of Atrial Fibrillation: Factors Affecting Success and Recurrence
- 94.4% success rate; median number shocks=2, median E 200J, median cumulative E 350J
- In 9 of 14 refractory cases, sinus rhythm was achieved after amiodarone administration.
- Recurrence rate 31%, median time 99d
-deteminants of success: MR and AFCL
-cumulative E required: catheter type, previous AF episode, TR and body weight
-recurrence within 1 year: sex (stallion), MR and AF duration. (or on the last AF episode alone, stallion, sotalol, MR, body weight)
Trigger, Substrate, Remodelling
Intravenous Loss of Over-the-Wire Catheter Guidewires in Horses
plain radiographs are a good diagnostic choice.
8 removed: percutaneous endovascular or venotomy- only complication was one with thrombosis
5 left in: resumed previous performance (one now 10 years without complications)
